News from CROI 2018

The rate of new
HIV infections has halved since 2011 in a Ugandan community following large
increases in male circumcision, antiretroviral treatment and viral suppression,
Joseph Kagaayi of the Rakai Health Sciences Program told the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) in Boston, USA.

MK-8591 or EFdA is a novel and exceptionally long-lasting and potent HIV drug, being developed by Merck. It is a nucleoside reverse transcriptase translocation inhibitor (NRTTI). Its potency and longevity are due to the fact that it acts at two stages of the HIV lifecycle: as well as blocking HIV from making a DNA copy of its genes that can be inserted into a human cell, it also blocks integrated HIV DNA inside cells from being turned back into viruses.

HIV self-testing is feasible and acceptable for men who have sex with men and transgender women, engaging more people than usual testing services, according to the results of a randomised trial in Burma presented to the conference.

A presentation at the conference describes what
appears to be another case of infection with HIV in someone consistently taking pre-exposure prophylaxis (PrEP). However, a lack of monitoring and a
failure to give the subject an HIV test around the time he experienced what may have
been HIV seroconversion symptoms means that it is difficult to be 100% certain
that this is a case of PrEP failure.

A study presented at the conference aims to
quantify how many people with HIV there might be in the community who both have
a detectable HIV viral load and also have significant resistance to tenofovir
and emtricitabine, the two drugs currently used in pre-exposure prophylaxis
(PrEP).

Ibalizumab, a long-acting monoclonal antibody
that prevents HIV from entering cells, is active against virus strains that
have developed resistance to multiple other antiretrovirals, according to a
poster presentation at the conference.

Two open-label, parallel studies of vaginal rings used to
prevent HIV in women released interim results at the conference. Although, as open-label studies, there was no placebo arm and so no
direct comparison with no intervention, the researchers estimated that
in both studies there were 54% fewer HIV infections than there would have been
on a placebo.

The antiretroviral drug efavirenz significantly reduces the levels
of both hormones in the vaginal ring contraceptive in women with HIV, Kimberly
Scarsi of University of Nebraska Medical Center reported at the conference.

The average time from HIV diagnosis to treatment initiation
in San Francisco shrank from 35 days to six days between 2013 and 2016 as the
city implemented its RAPID programme to speed up treatment starts, Oliver Bacon
of San Francisco Department of Public Health reported at the conference.

A phylogenetic study of HIV infections in Los Angeles has
found that transgender women (TGW) are more likely than any other risk group
to be in a genetically connected cluster of cases, which is a marker of high
HIV risk. But they are less likely than gay men and other men who have sex with
men (MSM), who also tend to be in transmission clusters, to be diagnosed.

The number of people
taking HIV pre-exposure prophylaxis (PrEP) in the United States is steadily
increasing, exceeding 77,000 in 2016, according to figures released
by AIDSVu in conjunction with the conference.

People who switched to a single-tablet regimen containing the
integrase inhibitor bictegravir were as likely to maintain an undetectable
viral load as those who stayed on their current suppressive regimen containing
dolutegravir, according to a presentation at the conference.

Starting treatment at home, on the day of diagnosis, proved
acceptable in rural Lesotho and resulted in improved linkage to care and viral
suppression compared with routine care, Niklaus Labhardt of the Swiss Public
Health Institute reported at the conference.

Twice-daily dosing of dolutegravir when
combined with the tuberculosis (TB) drug rifampicin is safe and effective and will allow
dolutegravir to be used alongside TB treatment as part of first-line antiretroviral therapy (ART), according to results of the
INSPIRING study presented at the conference.

Antiretroviral drug
levels in a sample of hair were the strongest predictor of response to HIV
treatment, and this method also holds promise for monitoring adherence to
pre-exposure prophylaxis (PrEP), according to research presented at the conference.

A one-month course
of the antibiotic rifapentine combined with isoniazid was just as effective as
a nine-month course of isoniazid in preventing the development of tuberculosis (TB)
in people with HIV in a large international study presented at the conference.

A
US study of HIV gene sequences in networks with a particularly high HIV
infection rate has found the highest rates in groups containing more young
gay men, which is not unexpected, but also in more Latino than black men, which
may signal a shift in the demographics of those most at risk of HIV.

Screening for tuberculosis (TB) and intensified follow-up of TB cases in
people starting antiretroviral therapy and urine-based screening of inpatients
with HIV both have the potential to significantly reduce deaths and improve
rates of TB treatment in people with HIV, according to results
of two large studies presented at the conference.

A study presented at the conference found that women in two prevention studies were nearly three
times more likely to become infected with HIV while they were pregnant, and four
times as likely in the six months after giving birth, compared with the risk of
HIV infection at other times.

Treatment with a broadly
neutralising antibody plus an immune-stimulating drug led to long-term viral remission
after interrupting antiretroviral therapy in a monkey study, according to data presented
at the conference.

Other aidsmap news

People
with HIV who have other medical conditions such as high blood pressure
or high lipids appear to do better if they have a primary care physician
as well as an HIV physician, according to a study of people receiving
care through UCLA Center for Clinical AIDS Research and Education,
researchers report in The Journal of Infectious Diseases.

HIV
prevention programmes targeted at men who have sex with men (MSM)
should include intimate partner violence (IPV) screening and
interventions, research published in Nature Scientific Reports shows.
Investigators from China found that recent experience of IPV was
associated with a fourfold increase in the risk of infection with HIV.
Moreover, experiencing IPV was a more important risk factor for
infection with HIV than several other factors traditionally associated
with high HIV risk, with 38% of the risk attributed to IPV.

Increased
time spent living with depression is associated with poorer engagement
with the HIV care continuum, investigators from the United States report
in JAMA Psychiatry. Chronic depression was associated with missing
appointments, a detectable viral load and an increased mortality risk.

The biggest barrier to HIV pre-exposure prophylaxis (PrEP)
becoming more available and more widely used is not cost so much as widespread acceptance
of the status quo in HIV prevention, the first-ever European PrEP Summit, held
in Amsterdam in February, heard.

People
with hepatitis C in the United States are at least three times more
likely to smoke than the general population but little is being done to
help them stop smoking, and US researchers say it is folly to spend huge
sums on hepatitis C treatment without trying to help patients stop
smoking.

People
with HIV treated for aggressive forms of non-Hodgkin lymphoma or
Burkitt lymphoma appear no more likely to suffer a relapse after
treatment than HIV-negative people treated for the same conditions,
according to findings of an analysis of the German HIV Lymphoma Cohort
published in Haematologica, the journal of the European
Hematology Association.

Hepatitis
C virus (HCV)-related liver fibrosis improves significantly in the
majority of people with pre-treatment advanced fibrosis or cirrhosis
after treatment resulting in a sustained virological response, Swedish
investigators report in the Journal of Viral Hepatitis.

HIV-positive
gay men in France have a very high prevalence of anal infection with
strains of human papillomavirus (HPV) associated with a high risk of
anal cancer, investigators report in The Journal of Infectious Diseases.
HPV16 was the most commonly detected high-risk HPV (HR-HPV) strain.

People
with HIV in Zambia were at least ten times more likely to die in the
first two years after starting antiretroviral treatment than European
patients, according to findings of a study which traced people lost from
HIV care in Zambia.

Darunavir/ritonavir
(DRV/r) is the most durable boosted protease inhibitor for
antiretroviral therapy (ART)-experienced people, investigators from the
EuroSIDA cohort report in HIV Medicine. People switching treatment to a
DRV/r-containing regimen had a significantly lower risk of virological
failure and/or treatment discontinuation compared to people changing to
combinations including either atazanavir/ritonavir (ATZ/r) or
lopinavir/ritonavir (LPV/r).

There
is a high prevalence of hypertension among HIV-positive people in the
United States and many of these individuals are not receiving
hypertensive therapy, investigators report in Open Forum Infectious
Diseases. Overall, 42% of people were classified as hypertensive and 13%
of these people were undiagnosed with a further 26% with uncontrolled
high blood pressure despite therapy.

People with HIV in Tanzania were more likely to report problems with
non-adherence to antiretroviral treatment after their healthcare
providers underwent training in patient-centred communication skills and
how to discuss adherence with patients, findings from a cohort study
published in HIV Medicine show.

The US Food and Drug Administration (FDA) has approved Biktarvy, Gilead Sciences' new single
tablet antiretroviral regimen containing the HIV integrase inhibitor
bictegravir, which was highly effective and well tolerated in clinical trials.

The potential savings from prescribing generic antiretrovirals predicted
by economic models may be overstated and numerous barriers need to be
overcome to bring down the cost of HIV treatment in higher-income
countries, according to the findings of several recently published
analyses.

HIV-positive women in Switzerland are mainly relying on male condoms for contraception, investigators report in HIV Medicine.
Two-thirds of reproductive age women reported using contraception, with
three-quarters of these individuals putting their trust in male
condoms. Unwanted pregnancies were not uncommon among women using
contraception.

A
study examining pharmacokinetic interactions between the first-line HIV
drug dolutegravir and a once-weekly tuberculosis regimen was terminated
early after National Institutes of Health (NIH) researchers found that the combined use of the
treatments led to “unexpected and serious toxicities” in healthy
participants.

It's
precisely because of the overwhelming success in recent years of oral
PrEP that the future of the anal douche and other sorts of topically
applied anti-HIV agents, such as gels and dissolvable films, all loosely
termed "microbicides," is suddenly up in the air, if not outright
doomed.

New
NCCN guidelines for cancer in people living with HIV seek to reduce
unnecessary, deadly cancer care gaps. “The disparity in cancer care is
large and significant. For most cancers, people living with HIV are
two to three times more likely to receive no cancer treatment compared
to uninfected people,” said Gita Suneja, MD, Duke Cancer Institute.

Recent
research, conducted in Vancouver, British Columbia with HIV-positive
and HIV-negative men who have sex with men, found that awareness of
treatment as prevention is increasing, but still unevenly distributed
with HIV-negative men and men with lower social capital less likely to
be aware or accepting of treatment as prevention information.

The
International AIDS Society (IAS) has announced that Mexico City,
Mexico, will host the 10th IAS Conference on HIV Science (IAS 2019). IAS
2019 will take place at the Centro Citibanamex from 21-24 July 2019.

During
their 13 months in power, the Trump administration has made it
abundantly clear that they have no desire to protect the rights of the
LGBT community and, if anything, are actively looking to undermine them.

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